Do I need to be tested for prostate cancer?

Making the decision to have a PSA test depends on a variety of factors. Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for...

My PSA level is 10. What do I need to do?

The PSA is used as a guide to estimate the risk of prostate cancer. The higher the PSA, the greater the chance of prostate cancer. PSA levels under 4 ng/mL: “normal” 4 to 10 ng/mL: 20 to 30% risk 10 to 20 ng/mL: 50 to 75% risk Above 20 ng/mL: 90%. When prostate cancer develops, the PSA level usually goes above 4. Still, a level below 4 does not guarantee that a man doesn’t have cancer – about 15% of men with a PSA below 4 will have prostate...

Treatments

Side Effects

Many men understand that when prostate cancer is caught early, it can be treated effectively, and the primary treatment options for localized disease are all excellent choices. However, many men also have significant concerns about the side effects of these treatments.

The concerns are justified, but there are many misunderstandings about how often side effects occur, how severe they really are and what can be done to manage them and counteract their occurrence.

Many of the side effects that men fear most following local treatment are often less frequent and severe than they might think, thanks to:

Technical advances in both surgery and radiation therapy

Researchers persistently seeking new ways to help overcome side effects

Improvements in treatment delivery

It’s still important to understand how and why these effects occur, and to learn how you can minimize their impact on your daily life.

Depending on the treatment strategy used, some or all of these effects might be present. It’s also important to realize that not all symptoms are normal, and that some require immediate care.

The below table is an attempt to compare three of these side effects across the different local therapies (NNSRP=non-nerve sparing radical prostatectomy, NSRP=nerve sparing radical prostatectomy, EBRT=external beam radiation therapy, BT=brachytherapy).

Each table shows the proportion of men three years after therapy with sexual dysfunction (left), bowel problems (middle), and urinary incontinence (right).

Yellow indicates normal function

Blue indicates mild dysfunction

Red indicates more severe dysfunction

These figures are shown for men with normal function prior to therapy.

Reproduced from the Journal of Clinical Oncology 2009; 27: 3916-3922.

Of course, exact figures will differ across institutions and surgeons or radiation oncologists. The figures here are only meant to be a guide to help understand these risks over time. The numbers will also differ if there is already dysfunction present prior to surgery or radiation, as the risks of side effects are increased in this setting.

If you have erectile dysfunction before either surgery or radiation, the therapy will not reverse that. In contrast, urinary obstruction symptoms can often improve after surgery and occasionally after radiation. Urinary incontinence can also improve after these local therapies.